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MONTANA
Clear Form UCH-1
Rev 02 19

Report of Property Presumed Unclaimed

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Name of Holder _________________________________ 1. FEIN Ext. _______

- - U C H
Address _______________________________________ 2. Acct ID

Address _______________________________________ 3. Report Year
4. Report Number ______ See Instructions.
City __________________________________________ The original report is considered report number 1.

5. If you are no longer in business and want your account
State __________________Zip ____________________ closed, enter your final date.

Check this box if your address has changed. - -

Section I:
q Non Life Insurance Company Holder Report q Life Insurance Company Holder Report
(Report Year July 1 through June 30) (Report Year January 1 through December 31)
Total amount remitted from Section II, page 2. Remit one payment for the total amount.
The amount remitted is for all items held and owing that have remained unclaimed, unpaid
$__________________ and are presumed abandoned/unclaimed. See instructions for payment options.

___________________ Total number of properties reported on Section II, page 2.
Total number of shares reported on Section III, page 3.
___________________ For information related to the transfer of securities, see instructions on page 8.

Name of Contact ________________________________ Address _______________________________________

Phone ________________________________________ Address _______________________________________

Email _________________________________________ City __________________________________________

State __________________Zip ____________________

I, the undersigned, declare under penalty of perjury, that to the best of my knowledge and belief, the following is a
true and complete report of unclaimed property now in possession or under control of the holder, which is presumed
unclaimed in accordance with Montana law, 70-9-801 through 70-9-829, MCA. Written notice has been sent to the
apparent owner as prescribed under Montana law, 70-9-808(5), MCA.

Name of Officer or Holder Authorized to Sign Report (please print) _________________________________________

Signature ______________________________________________________ Date ___________________________

Title _____________________________________ Phone _____________________ Fax ______________________

Filing this Form: Mail the completed form to:

E-File options available at Montana Department of Revenue
revenue.mt.gov PO Box 5805
Helena MT 59604-5805

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                                                                                                             MONTANA
                                           Report of Property Presumed Unclaimed                             UCH-1

   Section II
   Column 1       Column 2                 Column 3        Column 4                  Column 5                Column 6
   NAUPA         Date of Last Transaction/ Amount Due to  Owner Social Security      Owner Name              Last Known Mailing Address 
   Property Type Date Payable              Owner          Number or Federal Employee (last name, first name,  (street, city, state, zip code)
   Code          (MMDDYYYY)                                Identification Number     middle initial)
                                                          (no dashes or slashes)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

             Total Amount Remitted   $

Important: If additional space is needed, make copies of this page. If Section II is not reproduced exactly as formatted on this page, report 
processing will be delayed until we receive the correctly formatted information.

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                                                                                                        MONTANA
                                           Report of Property Presumed Unclaimed                        UCH-1

   Section III. CUSIP Number ______________________________
   Column 1       Column 2                 Column 3   Column 4                  Column 5                Column 6
   NAUPA         Date of Last Transaction/ Number of Owner Social Security      Owner Name              Last Known Mailing Address 
   Property Type Date Payable              Shares    Number or Federal Employee (last name, first name,  (street, city, state, zip code)
   Code          (MMDDYYYY)                           Identification Number     middle initial)
                                                     (no dashes or slashes)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

                 Total Number of Shares

Important: If additional space is needed, make copies of this page. If Section III is not reproduced exactly as formatted on this page, report 
processing will be delayed until we receive the correctly formatted information.
                                                      3

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Report of Property Presumed Unclaimed
Instructions for Reporting Property
If you have questions, please call us at (406) 444-6900.

General Information
What is Unclaimed Property? Any financial asset for which an owner has not generated activity during a period of
time (see reporting requirements below) is considered unclaimed property. These assets may include uncashed checks,
savings, checking, payroll (wages, bonuses, commissions), credit balances, money orders, customer deposits, travelers
checks, stocks and bonds (uncashed dividends, interest checks, underlying shares principle), insurance proceeds,
certificates of deposit, and other intangible interests or benefits.
What is the Holder’s Responsibility? The holder of unclaimed property is required to send written notice to the apparent
owner of property with a value exceeding $50, not more than 120 days or less than 60 days before filing the report.
Please Note: Property owed to an unlocatable mineral owner in which a trust was created in a Montana District Court
per 82-1-302, MCA, is payable based on the terms of the executed lease, ratification, a division order or any other related
document or instrument. A form is not required to remit this property.

Important Reporting Information
● Retain a copy of the filed report for your records and mail the original to us with your remittance.
● We will allow a dormancy charge (service charge) to be deducted from mineral property presumed abandoned only if
a valid and enforceable written contract exists between the holder and the owner under which the holder may impose
the charge. The dormancy may only be deducted if the holder regularly imposes the charge and it is regularly reversed
or otherwise canceled per 70-9-806, MCA.
● All property is required to be reported and remitted. However, the detail information regarding the unclaimed property
owner is not required for items where the owner is unknown.

Filing Options
Electronic Filing. A holder report can be filed electronically through the Montana ePass File Transfer Service (FTS).
Electronic filing is secure, encrypted, accurate and the most efficient way to report unclaimed property. To learn more, go
to unclaimedproperty.mt.gov.
Follow these instructions when submitting your report electronically:
● The report is required to be in a text file. Do not provide your report in an executable file format, as a statewide policy
for Montana will not allow us to accept this format from an external source.
● The text file is required to be in the current NAUPA format, which may be obtained at http://www.unclaimed.org/
reporting/.
● Do not encrypt or password protect the file.
● The department no longer accepts magnetic media such as compact discs, diskettes, tapes or USB devices
Paper Filing. Follow the instructions below.

Instructions for Page 1
Line 1 Enter your federal employer identification number (FEIN) on line 1. If you are filing for more than one location,
include your extension number for the specific location that is reporting.
Line 2 If you know your Account ID, provide it on line 2.
Line 3 Enter the year in which the report period ends.
Life insurance companies’ report year is January 1 through December 31, with the report due on May 1 of the
following year.
For all other holders, the report year is July 1 through June 30, with the report due on November 1 of that year.
Line 4 You may report more than once a year. In order for us to correctly process the additional reports, indicate the
report number on line 4. Your original report is always considered report number 1. When you file an additional
report, it is important that you do not include property that you listed on a previous report.
Line 5 If you are no longer in business and are filing a final report, enter the date that your business ceased operations.
If your address has changed from the last report filed, check the box provided.

Section I:

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● Check the type of holder report being submitted.
● The amount remitted is for all items held and owing that has remained unclaimed, unpaid and is presumed abandoned.
The amount remitted is the total from Section II, page 2. You can pay by:
○ scheduling an ACH Credit payment through your bank. Visit online service at revenue.mt.gov for more information.
○ sending a check, along with the completed UCH-1 payment voucher.
● Enter the total number or properties you are reporting.
● The total number of shares reported is the total from Section III, page 2. See the instructions on page 8 for information
related to the transfer of securities or call us at (406) 444-6900.

Instructions for Page 2
You may photocopy page 2 of this report if additional space is needed. A computer printout is acceptable in place of
Section II and Section III of this report. If Sections II and III are not reproduced exactly as formatted on this page, report
processing will be delayed until we receive the correctly formatted information. If a printout is used, the print size is
required to be at least a 10-point font. Attach a copy of the printout to page 1 of this report.
Section II. Complete all columns.
Property owed to an unlocatable mineral owner in which a trust was created in a Montana District Court pursuant
to 82-1-302, MCA, is payable based on the terms of the executed lease, ratification, a division order or any other
related document or instrument. A form is not required to remit this property.
Column 1 Enter the NAUPA property type code for each property reported. A detailed list of NAUPA codes is included
in these instructions for your convenience.
Column 2 Enter the date of the last transaction or date payable for the property being reported. Format the date as
MMDDYYYY.
Column 3 Enter the amount due to each owner.
Column 4 For each owner, enter the social security number or federal employer identification number.
Column 5 List each owner by last name, first name and middle initial.
● In the case of unclaimed funds held or owed under any life or endowment insurance policy or annuity
contract, list the name of the insured or annuitant and the name of the beneficiary.
● In the case of unclaimed insurance policy benefits, list the insured’s or annuitant’s name first and
beneficiary’s name second.
● In the case of custodial or trustee accounts, list the owner’s name first and the custodian’s or trustee’s
name second.
● In the case of cashier’s checks or money orders, list the payee’s name first and the remitter’s name
second.
Column 6 For each owner, provide the last known mailing address including street, city, state and zip code.
Section III. Complete all columns.
Provide the CUSIP number for the securities being reported.
Column 1 Enter the NAUPA property type code for each property reported. A detailed list of NAUPA codes is included
in these instructions for your convenience.
Column 2 Enter the date of the last transaction or date payable for the securities being reported.
Column 3 Enter the number of shares for each owner.
Column 4 For each owner, enter the social security number or federal identification number.
Column 5 In alphabetical order, list each owner by last name, first name and middle initial.
Column 6 For each owner, provide the last known mailing address including street, city, state and zip code.

NAUPA Adopted Standard Property Type Codes
The following codes have been endorsed by NAUPA for use by each state in the development of standard reporting;
however, some states do not currently accept these codes. The State of Montana’s agreement to utilize these codes is a
step toward standardization in unclaimed property reporting.

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                             Montana Department of Revenue
                         Property Codes with Dormancy Periods

NAUPA                                       Dormancy  NAUPA                                    Dormancy 
               Description                                            Description
Code                                        Period  Code                                       Period
                                            Account Balance Due
AC01  Checking Accounts                     5       AC06    Security Deposits                  5
AC02  Savings Accounts                      5       AC07    Unidentified Deposits              5
AC03  Matured CD or Savings Certificate     5       AC08    Suspense Accounts                  5
AC04  Christmas Club Account                5       AC99    Aggregate Account Balances         5
AC05  Money on Deposit to Secure Funds      5
                                            Uncashed Checks
CK01  Cashier’s Checks                      5       CK10    Expense Checks                     5
CK02  Certified Checks                      5       CK11    Pension Checks                     5
CK03  Registered Checks                     5       CK12    Credit Checks or Memos –  Non-     5
                                                            Retail
CK04  Treasurer’s Checks                    5       CK13    Vendor Checks                      5
CK05  Drafts                                5       CK14    Checks Written off to Income       5
CK06  Warrants                              5       CK15    Other Outstanding Official Checks  5
CK07  Money Orders                          7       CK16    CD Interest Checks                 5
CK08  Traveler’s Checks                     15      CK99    Aggregate Un-cashed Checks         5
CK09  Foreign Exchange Checks               5
                                     Educational Savings Accounts
CS01  Educational Savings Accounts – Cash   3       CS03    Educational Savings Accounts –     3
                                                            Securities
CS02  Educational Savings Accounts –        3       CS04    Educational Savings Accounts – 
      Mutual Fund                                           Reserved for future use
                                            Court Deposits
CT01  Escrow Funds                          1       CT04    Suspense Accounts                  1
CT02  Condemnation Awards                   1       CT05    Other Court Deposits               1
CT03  Missing Heirs’ Funds                  1       CT99    Aggregate Court Deposit            1

                                          Health Savings Accounts
HS01  Health Savings Account                3       HS02    Health Savings Account Investment  3
HS03  Health Savings Account – Reserved 
      for future use

                                            Insurance
IN01  Individual Policy Benefits or Claim   5       IN05    Premium Refunds                    5
      Payment – All Other
IN21  Individual Policy Benefits or Claim   3       IN06    Unidentified Remittances           5
      Payment – Life, Endowment or 
      Annuity
IN02  Group Policy Benefits or Claim        5       IN07    Other Amounts due Under Policy     5
      Payments – All Others                                 Terms
IN22  Group Policy Benefits or Claim        3       IN08    Agent Credit Balances              5
      Payments – Life, Endowment or 
      Annuity
IN03  Proceeds Due Beneficiaries            3       IN99    Aggregate Insurance Property       5
IN04  Proceeds from Matured Policies,       3
      Endowments or Annuities

                                     Individual Retirement Account
IR01  Traditional IRA – Cash                3       IR06    Roth IRA – Mutual Funds            3
IR02  Traditional IRA – Mutual Funds        3       IR07    Roth IRA – Securities              3
IR03  Traditional IRA – Securities          3       IR08    Roth IRA – Reserved for future use
IR04  Traditional IRA – Reserved for future         IR09    IRA Other – Reserved for future use
      use
IR05  Roth IRA – Cash                       3       IR10    IRA Other – Reserved for future use

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Montana Department of Revenue Property Codes with Dormancy Periods continued...

NAUPA                                     Dormancy  NAUPA                                      Dormancy 
                Description                                          Description
Code                                      Period  Code                                         Period
                                 Mineral Proceeds & Mineral Interest
MI01  Net Revenue Interest                5       MI06    Bonuses                              5
MI02  Royalties                           5       MI07    Delay Rentals                        5
MI03  Overriding Royalties                5       MI08    Shut-in Royalties                    5
MI04  Production Payments                 5       MI09    Minimum Royalties                    5
MI05  Working Interest                    5       MI99    Aggregate Mineral Proceeds           5
                       Miscellaneous Checks & Intangible Personal Property
MS01 Wages. Payroll, Salary               1       MS11    Refunds Due – Retail                 3
MS02 Commissions                          1       MS12    Unredeemed Gift Certificates         3
MS03  Workers Compensation Benefits       5       MS13 Unclaimed Loan Collateral               5
MS04 Payments for Goods & Services        5       MS14    Pension & Profit Sharing – IRA/Keogh 3
MS05 Customer Overpayments - Retail       3       MS15 Dissolution or Liquidation              1
MS06  Unidentified Remittance             5       MS16 Misc. Outstanding Checks                5
MS07 Un-refunded Overcharges – Retail     3       MS17 Misc. Intangible Property               5
MS08 Accounts Payable                     5       MS18 Suspense Liabilities                    5
MS09 Credit Balance – Accounts Receivable 3       MS99 Aggregate Misc. Property                5
      – Retail
MS10 Discount Due - Retail                3
                                          Securities
SC01  Dividends                           5       SC12    Underlying Shares or Other           5
                                                          Outstanding Certificates
SC02  Interest (Bond Coupons)             5       SC13    Funds for Liquidation/Redemption of  5
                                                          Un-surrendered Stocks or Bonds
SC03  Principal Payments                  5       SC14    Debentures                           5
SC04  Equity Payments                     5       SC15    US Gov’t Securities                  5
SC05  Profits                             5       SC16    Mutual Fund Shares                   5
SC06  Funds Pd to Purchase Shares         5       SC17    Warrant (Rights)                     5
SC07  Funds for Stocks & Bonds            5       SC18    Mature Bond Principal                5
SC08  Shares of Stock (Returned by Post   5       SC19    Dividend Reinvestment Plans          5
      Office)
SC09  Cash for Fraction Shares            5       SC20    Credit Balances                      5
SC10  Un-exchanged Stock of Successor     5       SC99    Aggregate Security Related Cash      5
      Corp
SC11         Other Cert of Ownership      5
                                 Safe Deposit Boxes & Safekeeping
SD01            SD Box Contents           5       SD04    Unclaimed Loan Collateral            5
SD02          Other Safekeeping           5       SD05            Liquidated Assets            5
SD03          Other Tangible Property     5
                                 Trust Investment & Escrow Accounts
TR01          Paying Agent Account        5       TR04            Escrow Accounts              5
TR02  Undelivered or Uncashed Dividends   5       TR05              Trust Vouchers             5
TR03  Funds held in Fiduciary Capacity    5       TR99    Aggregate Trust Property             5
                                            Utilities
UT01            Utility Deposits          1       UT04    Capital Credit Distributions         5
UT02            Membership Fees           1       UT99            Aggregate Utilities          1
UT03          Refunds or Rebates          1
                                            Other
ZZZZ  Property Not Identified Above       5

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Reporting and Delivery of Securities Property
When reporting securities, remember that your report is not complete until you provide evidence of the property being
transferred into the ownership of the State of Montana. The required evidence depends on the type of security and how it
will be delivered to our custodian on behalf of the state.
I. STOCK REMITTANCES
Two days prior to delivery, you are required to fax an intent to deliver to:
(1) Avenu Insights & Analytics - (617) 722-9660, Attn: Custody Department, and
(2) Montana Department of Revenue Unclaimed Property - (406) 444-7997, Attn: Miscellaneous Tax Unit
Your fax is required to include:
• CUSIP numbers • delivering party’s DTC numbers
• number of shares • certificate numbers and registration (for physical certificates)
• issue names • copy of statement (for DRS/Book Shares)
Direct Transfer (All eligible shares are required to be deposited through DTC or DWAC if not a DTC participant)
Nominee:
Glory of the West & Co.
FEIN: 83-0367507
DTC Participant: 0901
Agent Bank: 26500
Account: 822441

Book Entry Shares/Direct Registration Shares (DRS)/Dividend Reinvestment Shares (DRP) & Closed-End Funds
Nominee: Address:
Glory of the West & Co. Avenue Insights & Analytics
FEIN: 83-0367507 100 Hancock Street, 10th floor
Quincy, MA 02171
Note: Dividend Reinvestment Plans (DRP) & Closed-End funds please close the accounts and forward whole shares via DTC.
Fractional shares must be sold at the owner level and the proceeds applied to each individual owner with a check for the total
proceeds delivered with your report. You are required to include a confirmation with your Report of Unclaimed Property stating that
Glory of the West & Co. is the owner of the shares. Also, fax a copy of the confirmation to the State of Montana, (406) 444-7997.
Physical Certificates (non-DTC eligible shares only)
Nominee: Address:
Glory of the West & Co. The Depository Trust Company
FEIN: 83-0367507 570 Washington Blvd - 5th Floor
Jersey City, NJ 07310
Attn: BNY Mellon/Brench Deposit Department
Note: Send the original certificate to custodian at the above address; send a photocopy of the certificate with your report--do not
deliver the original certificate to the State of Montana with your report. Send only one certificate for each security position reported.
II. MUTUAL FUNDS (Include complete fund names, FEINs and CUSIP numbers. Set up account so dividends are
reinvested.)
Send interested party statements to: Register funds as follows:
Avenu Instights & Analytics MAC & CO
Attn: Custody Department Mutual Fund Operation
100 Hancock Street, 10th Floor PO Box 3198
Quincy, MA 02171 Pittsburgh, PA 15230-3198
Account: 822441
FEIN: 23-6019000
Open end mutual funds: Contact Xerox at UPCH.Custody@avenuinsights.com to obtain account numbers 3-4 days prior to
attempting delivery.
Note: You are required to include a statement with your Report of Unclaimed Property listing the shares in the state’s name. Fax a copy
of this statement to Avenue Insights & Analytics (617) 722-9660.
III. WORTHLESS SECURITIES
Do not report worthless, nontransferable or restricted securities.
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